CREDIT APPLICATION: 1728 Kelly Park Road · Apopka, FL 32712 · Tel: (407) 889-8055 · Fax: (407) 889-2523
Company Name: __________________________________________________________________________
Address: _________________________________________________________________________________
Phone No: _______________________________	Fax No: ___________________________________

Years established under above name:________ Years at present location:_________
Resale Tax Certificate #: ____________________________________________________________________
The business is a:    [   ] Corporation       [   ] Partnership       [   ] Proprietorship        [   ] L.L.C.
If a corporation: We are incorporated under the state law of _______________ Corp I.D. No. ______________
Parent Co. ________________________________________________________________________________
In the past 5 years have you operated under other names?    [   ] Yes        [   ] No
If yes, list name(s) and location(s) _____________________________________________________________
The principal owners or officers are:
Name:	________________________	_______________________	_______________________
Address:	________________________	_______________________	_______________________
Address:	________________________	_______________________	_______________________
Phone:	________________________	_______________________	_______________________
Our 3 major sources of supply with whom we have open accounts are:
Name:	1_______________________	2 _______________________	3 ______________________
Address:	_______________________	_______________________	______________________
Address:	_______________________	_______________________	______________________
Phone No:	_______________________	_______________________	______________________
Fax No:	_______________________	_______________________	______________________

Bank Reference:

Name:     ______________________________________________________________________________

Address:  ______________________________________________________________________________

City:         ___________________________________________________ State:_______ Zip: __________

Phone No:_______________     Fax No:  _____________  Account No: ___________________________

Have you ever filed bankruptcy?    [   ]Yes      [   ] No

If yes, please explain: _____________________________________________________________________

Do you require a purchase order number on your orders?    [   ] Yes      [   ] No

We understand that all information is for the purpose of obtaining credit, and such information will be handled in strictest confidence. The undersigned has read, and agrees to the Term and Conditions of this contract. In the absence of an original copy of this application, a faxed copy will be considered as the original for purposes of this agreement.

The undersigned does hereby authorize the release of all information needed to verify the contents of this application, or to otherwise process the application, including, bur not limited to, contacting third parties concerning the credit worthiness of the applicant.

Interest will be charged at the rate of 1.5% per month on all past due invoice. You will be responsible for any further charges incurred for collection. I/We further represent and warrant that the facts and matters stated in this credit application are true and correct.

The laws of the state of Florida shall be applicable to any suit arising fromthe agreement. In the event of litigation, venue shall be in Orange County,Florida. This signed application will apply to all Agri-Starts companiesincluding AS-1, AS-2, AS-3, AS-4 and AMI. I have read and agree to all terms andconditions of this application.

Signature: __________________________________  Printed Name:________________________________ Title: _____________________________________________   Date:________________________________